In Reply The ACA deserves credit for bringing new emphasis to the debate about network adequacy standards—many types of insurance in many states are currently not subject to any adequacy standards at all. We remain convinced of the potential for narrow networks to improve the quality of care and contain costs.

However, as Dr Weiss notes, they equally hold the potential to limit access inappropriately and to cause significant harm, financial or healthwise. Discrepancies between the network status of hospitals and hospital-based physicians offer one such particularly negative example that may confuse even well-informed consumers.